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Janahiraman S, Shahril NS, Jayaraj VJ, Ch'ng S, Eow LH, Mageswaren E, Lim AL, Chong HC, Ong PS, Ismail AM, Rahim SMA, Ng CR, Suahilai DM, Ramlan AH, Too CL, Leong CO. A hierarchical cluster analysis for clinical profiling of tofacitinib treatment response in patients with rheumatoid arthritis. Clin Rheumatol 2024; 43:2489-2501. [PMID: 38922551 DOI: 10.1007/s10067-024-07035-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/19/2024] [Accepted: 06/14/2024] [Indexed: 06/27/2024]
Abstract
Tofacitinib is the first oral JAK inhibitor approved for treating rheumatoid arthritis (RA). To enhance our understanding of tofacitinib drug response, we used hierarchical clustering to analyse the profiles of patient who responded to the treatment in a real-world setting. Patients who commenced on tofacitinib treatment were selected from 12 major rheumatology centres in Malaysia. The aim was to assess their response to tofacitinib defined as achieving DAS28-CRP/ESR ≤ 3.2 and DAS28 improvement > 1.2 at 12 weeks. A hierarchical clustering analysis was performed using sociodemographic and clinical parameters at baseline. All 163 RA patients were divided into three clusters (Clusters 1, 2 and 3) based on specific clinical factors at baseline including bone erosion, antibody positivity, disease activity and anaemia status. Cluster 1 consisted of RA patients without bone erosion, antibody negative, low baseline disease activity measure and absence of anaemia. Cluster 2 comprised of patients without bone erosion, RF positivity, anti-CCP negativity, moderate to high baseline disease activity score and absence of anaemia. Cluster 3 patients had bone erosion, antibody positivity, high baseline disease activity and anaemia. The response rates to tofacitinib varied among the clusters: Cluster 1 had a 79% response rate, Cluster 2 had a 66% response rate, and Cluster 3 had a 36% response rate. The differences in response rates between the three clusters were found to be statistically significant. This cluster analysis study indicates that patients who are seronegative and have low disease activity, absence of bone erosion and no signs of anaemia may have a higher likelihood of benefiting from tofacitinib therapy. By identifying clinical profiles that respond to tofacitinib treatment, we can improve treatment stratification yielding significant benefits and better health outcomes for individuals with RA.
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Affiliation(s)
- Sivakami Janahiraman
- School of Postgraduate Studies, IMU University, Kuala Lumpur, Malaysia.
- Department of Pharmacy, Hospital Selayang, Ministry of Health Malaysia, Selangor Darul Ehsan, Malaysia.
| | - Nor Shuhaila Shahril
- Rheumatology Unit, Department of Medicine, Hospital Putrajaya, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Vivek Jason Jayaraj
- Sector for Biostatistics & Data Repository, National Institutes of Health Complex, Ministry of Health Malaysia, Selangor Darul Ehsan, Malaysia
| | - Suyin Ch'ng
- Rheumatology Unit, Department of Medicine, Hospital Selayang, Ministry of Health Malaysia, Selangor Darul Ehsan, Malaysia
| | - Liu Hong Eow
- Rheumatology Unit, Department of Medicine, Hospital Tuanku Ja'afar Seremban, Ministry of Health Malaysia, Negeri Sembilan, Malaysia
| | - Eashwary Mageswaren
- Rheumatology Unit, Department of Medicine, Hospital Tengku Ampuan Rahimah, Ministry of Health Malaysia, Selangor Darul Ehsan, Malaysia
| | - Ai Lee Lim
- Rheumatology Unit, Department of Medicine, Hospital Pulau Pinang, Ministry of Health Malaysia, Pulau Pinang, Malaysia
| | - Hwee Cheng Chong
- Rheumatology Unit, Department of Medicine, Hospital Melaka, Ministry of Health Malaysia, Melaka, Malaysia
| | - Ping Seung Ong
- Rheumatology Unit, Department of Medicine, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Perak Darul Ridzuan, Malaysia
| | - Asmahan Mohamed Ismail
- Rheumatology Unit, Department of Medicine, Hospital Raja Perempuan Zainab II, Ministry of Health Malaysia, Kelantan Darul Naim, Malaysia
| | - Siti Mariam Ab Rahim
- Rheumatology Unit, Department of Medicine, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia, Terengganu Darul Iman, Malaysia
| | - Chun Ruh Ng
- Rheumatology Unit, Department of Medicine, Hospital Sultan Ismail, Ministry of Health Malaysia, Johor Darul Ta'zim, Malaysia
| | - Dayang Masyrinartie Suahilai
- Rheumatology Unit, Department of Medicine, Hospital Tengku Ampuan Afzan, Ministry of Health Malaysia, Pahang Darul Makmur, Malaysia
| | - Azwarina Hanim Ramlan
- Rheumatology Unit, Department of Medicine, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Kedah Darul Aman, Malaysia
| | - Chun Lai Too
- Immunogenetic Unit, Institute for Medical Research, National Institutes of Health Complex, Ministry of Health Malaysia, Selangor Darul Ehsan, Malaysia
| | - Chee Onn Leong
- Centre for Cancer and Stem Cell Research Development and Innovation (IRDI), Institute for Research, IMU University, Kuala Lumpur, Malaysia
- AGTC Genomics, Kuala Lumpur, Malaysia
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Pope J, Finckh A, Silva-Fernández L, Mandl P, Fan H, Rivas JL, Valderrama M, Montoro M. Tofacitinib Monotherapy in Rheumatoid Arthritis: Clinical Trials and Real-World Data Contextualization of Patients, Efficacy, and Treatment Retention. Open Access Rheumatol 2024; 16:115-126. [PMID: 38883150 PMCID: PMC11179645 DOI: 10.2147/oarrr.s446431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 05/28/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose To evaluate the characteristics, efficacy, and retention of tofacitinib monotherapy in patients with rheumatoid arthritis using data from randomized controlled trials (RCTs) and real-world data (RWD). Patients and Methods Three patient groups receiving tofacitinib 5 mg twice daily (BID) monotherapy were defined for post hoc RCT/long-term extension (LTE) analyses: (1) disease-modifying antirheumatic drug (DMARD)-inadequate responder patients from phase 3/3b/4 RCTs; (2) methotrexate-naïve patients from a phase 3 RCT; and (3) index study patients continuing in an LTE study. Outcomes included low disease activity (LDA)/remission rates defined by Clinical Disease Activity Index (CDAI); Disease Activity Score in 28 joints (DAS28-4), erythrocyte sedimentation rate; DAS28-4, C-reactive protein (DAS28-4[CRP]); and rates of/time to discontinuation due to lack of efficacy/adverse events. RWD were identified by non-systematic literature searches of PubMed, Embase, and American College of Rheumatology/European Alliance of Associations for Rheumatology congress abstracts (2012-2022). Results RCT/LTE analyses included 1000/498 patients receiving tofacitinib 5 mg BID monotherapy. Baseline disease activity was high; patients tended to receive concomitant glucocorticoids; most were biologic DMARD-naïve. CDAI LDA rates were 32.2-62.2% for Groups 1/2 (months 3-12) and 64.0-70.7% for Group 3 (months 12-72). In Groups 1, 2, and 3, 4.0%, 15.6%, and 27.7% of patients, respectively, discontinued tofacitinib monotherapy due to lack of efficacy/adverse events. From 11 RWD publications, 16.6-66.1% received tofacitinib monotherapy. Consistent with clinical data, tofacitinib monotherapy effectiveness (month 6 CDAI LDA, 30.2%; month 3 DAS28-4[CRP] remission, 53.4%) and persistence were observed in RWD, with retention comparable to tofacitinib combination therapy. Conclusion Tofacitinib monotherapy demonstrated clinically significant responses/persistence in RCT/LTE analyses, with effectiveness observed and persistence comparable to combination therapy in RWD. Trial Registration NCT00814307, NCT02187055, NCT01039688, NCT00413699, NCT00661661 (ClinicalTrials.gov).
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Affiliation(s)
- Janet Pope
- Division of Rheumatology, University of Western Ontario, London, Ontario, Canada
| | - Axel Finckh
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
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D'Alessandro F, Cazzato M, Laurino E, Morganti R, Bardelli M, Frediani B, Buongarzone C, Moroncini G, Guiducci S, Cometi L, Benucci M, Ligobbi F, Marotto D, Mosca M. ToRaRI (Tofacitinib in Rheumatoid Arthritis a Real-Life experience in Italy): Effectiveness, safety profile of tofacitinib and concordance between patient-reported outcomes and physician's global assessment of disease activity in a retrospective study in Central-Italy. Clin Rheumatol 2024; 43:657-665. [PMID: 38135860 PMCID: PMC10834550 DOI: 10.1007/s10067-023-06836-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION The use of Janus Kinase Inhibitors (JAK-Is) in rheumatoid arthritis (RA) has entered in daily practice. In consideration of ORAL-Surveillance trial and the new EULAR recommendations, real-world data are needed to assess Jak-Is safety and effectiveness. The multicenter study presented here aimed to evaluate effectiveness and safety of tofacitinib in a real-life cohort. METHODS A retrospective analysis was performed from September 2021 to December 2022. Data were collected when tofacitinib was started (T0) and after 3 (T3), 6 (T6) and 12 (T12) months of treatment. The primary objective was to analyze the efficacy and safety of tofacitinib. Safety was assessed by recording adverse events (AEs) with and without discontinuation. The secondary objective was to assess the difference between Patient-Reported Outcomes (PROs) and Physician's Global Assessment of disease activity (PhGA). RESULTS 122 patients were included in the study from the following rheumatology Centers: Pisa, Ancona, Florence (two Centers), Siena, and Sardinia. A statistically significant improvement in DAS-28-CRP, CDAI and SDAI score was observed at T3, T6, compared to baseline (p < 0.001). Improvement was confirmed in patients who reach T12. Patients naïve to bDMARDs showed a shorter remission time and higher remission rates. There was also a statistically significant improvement in PROs compared to baseline (p < 0.001). The improvement was rapid and was consistent with PhGA. The 12-month retention rate for tofacitinib was 89.35%. Reasons to stop tofacitinib were: insufficient response (7), gastrointestinal symptoms (2), infection (1), malignancy (1), Zoster (1), pruritus sine materia (1). CONCLUSIONS Tofacitinib is safe and effective in our RA cohort. It induces higher remission rates in patients naive to bDMARDs, suggesting that there may be a benefit using it as first-line therapy. Additionally, improvement in PROs was consistent with PhGA scores, demonstrating how tofacitinib affects both the objective and subjective components of disease activity. Key Points 1. JAK inhibitors are considered at a similar level as biologic agents in terms of effectiveness. 2. After ORAL-Surveillance results, real-world data are needed to assess the benefit/risk profile of Jaki. 3. Disagreement between patients and physicians has been previously reported with biologic therapy among patients with rheumatoid arthritis, with patients rating disease activity higher than physicians. 4. Jak inhibitors could reduce this discrepancy, due to their mechanism of action.
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Affiliation(s)
| | | | | | | | - Marco Bardelli
- Rheumatology Unit-Department of Medicine, Surgery and Neurosciences-University Hospital Siena, Siena, Italy
| | - Bruno Frediani
- Rheumatology Unit-Department of Medicine, Surgery and Neurosciences-University Hospital Siena, Siena, Italy
| | - Claudia Buongarzone
- Internal Medicine Residency Programme, Marche Polytechnic University, Ancona, Italy
| | | | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Laura Cometi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Maurizio Benucci
- Rheumatology Unit, S.Giovanni Di Dio Firenze Hospital, Florence, Italy
| | - Francesca Ligobbi
- Rheumatology Unit, S.Giovanni Di Dio Firenze Hospital, Florence, Italy
| | | | - Marta Mosca
- Rheumatology Unit, University of Pisa, Pisa, Italy
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Chen PK, Tang KT, Chen DY. The NLRP3 Inflammasome as a Pathogenic Player Showing Therapeutic Potential in Rheumatoid Arthritis and Its Comorbidities: A Narrative Review. Int J Mol Sci 2024; 25:626. [PMID: 38203796 PMCID: PMC10779699 DOI: 10.3390/ijms25010626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/24/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune inflammatory disease characterized by chronic synovitis and the progressive destruction of cartilage and bone. RA is commonly accompanied by extra-articular comorbidities. The pathogenesis of RA and its comorbidities is complex and not completely elucidated. The assembly of the NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasome activates caspase-1, which induces the maturation of interleukin (IL)-1β and IL-18 and leads to the cleavage of gasdermin D with promoting pyroptosis. Accumulative evidence indicates the pathogenic role of NLRP3 inflammasome signaling in RA and its comorbidities, including atherosclerotic cardiovascular disease, osteoporosis, and interstitial lung diseases. Although the available therapeutic agents are effective for RA treatment, their high cost and increased infection rate are causes for concern. Recent evidence revealed the components of the NLRP3 inflammasome as potential therapeutic targets in RA and its comorbidities. In this review, we searched the MEDLINE database using the PubMed interface and reviewed English-language literature on the NLRP3 inflammasome in RA and its comorbidities from 2000 to 2023. The current evidence reveals that the NLRP3 inflammasome contributes to the pathogenesis of RA and its comorbidities. Consequently, the components of the NLRP3 inflammasome signaling pathway represent promising therapeutic targets, and ongoing research might lead to the development of new, effective treatments for RA and its comorbidities.
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Affiliation(s)
- Po-Ku Chen
- Rheumatology and Immunology Center, China Medical University Hospital, No. 2, Yude Road, Taichung 40447, Taiwan;
- College of Medicine, China Medical University, Taichung 40447, Taiwan
- Translational Medicine Laboratory, Rheumatology and Immunology Center, Taichung 40447, Taiwan
| | - Kuo-Tung Tang
- College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan;
- Division of Allergy, Immunology, and Rheumatology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Faculty of Medicine, National Yang-Ming University, Taipei 112304, Taiwan
| | - Der-Yuan Chen
- Rheumatology and Immunology Center, China Medical University Hospital, No. 2, Yude Road, Taichung 40447, Taiwan;
- College of Medicine, China Medical University, Taichung 40447, Taiwan
- Translational Medicine Laboratory, Rheumatology and Immunology Center, Taichung 40447, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan;
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
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5
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Yang V, Kragstrup TW, McMaster C, Reid P, Singh N, Haysen SR, Robinson PC, Liew DFL. Managing Cardiovascular and Cancer Risk Associated with JAK Inhibitors. Drug Saf 2023; 46:1049-1071. [PMID: 37490213 PMCID: PMC10632271 DOI: 10.1007/s40264-023-01333-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/26/2023]
Abstract
Janus kinase inhibitors (JAKi) have enormous appeal as immune-modulating therapies across many chronic inflammatory diseases, but recently this promise has been overshadowed by questions regarding associated cardiovascular and cancer risk emerging from the ORAL Surveillance phase 3b/4 post-marketing requirement randomized controlled trial. In that study of patients with rheumatoid arthritis with existing cardiovascular risk, tofacitinib, the first JAKi registered for chronic inflammatory disease, failed to meet non-inferiority thresholds when compared with tumor necrosis factor inhibitors for both incident major adverse cardiovascular events and incident cancer. While this result was unexpected by many, subsequently published observational data have also supported this finding. Notably, however, such a risk has largely not yet been demonstrated in patients outside the specific clinical situation examined in the trial, even in the face of many studies examining this. Nevertheless, this signal has practically re-aligned approaches to both tofacitinib and other JAKi to varying extents, in other patient populations and contexts: within rheumatoid arthritis, but also in psoriatic arthritis, axial spondyloarthritis, inflammatory bowel disease, atopic dermatitis, and beyond. Application to individual patients can be more challenging but remains important to harness the substantive potential of JAKi to the maximum extent safely possible. This review not only explores the evolution of the regulatory response to the signal, its informing data, biological plausibility, and its impact on guidelines, but also the many factors that clinicians must consider in navigating cardiovascular and cancer risk for their patients considering JAKi as immune-modulating therapy.
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Affiliation(s)
- Victor Yang
- Department of Rheumatology, Level 1, North Wing, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, PO Box 5444, Heidelberg West, VIC, 3081, Australia
| | - Tue W Kragstrup
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Sector for Rheumatology, Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Christopher McMaster
- Department of Rheumatology, Level 1, North Wing, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, PO Box 5444, Heidelberg West, VIC, 3081, Australia
- Department of Clinical Pharmacology and Therapeutics, Austin Health, Melbourne, VIC, Australia
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, VIC, Australia
| | - Pankti Reid
- Division of Rheumatology and Committee on Clinical Pharmacology and Pharmacogenomics, Department of Medicine, University of Chicago Biological Sciences Division, Chicago, IL, USA
| | - Namrata Singh
- Division of Rheumatology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Stine R Haysen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Philip C Robinson
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, Australia
| | - David F L Liew
- Department of Rheumatology, Level 1, North Wing, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, PO Box 5444, Heidelberg West, VIC, 3081, Australia.
- Department of Clinical Pharmacology and Therapeutics, Austin Health, Melbourne, VIC, Australia.
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.
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Paroli M, Becciolini A, Bravi E, Andracco R, Nucera V, Parisi S, Ometto F, Lumetti F, Farina A, Del Medico P, Colina M, Lo Gullo A, Ravagnani V, Scolieri P, Larosa M, Priora M, Visalli E, Addimanda O, Vitetta R, Volpe A, Bezzi A, Girelli F, Molica Colella AB, Caccavale R, Di Donato E, Adorni G, Santilli D, Lucchini G, Arrigoni E, Platè I, Mansueto N, Ianniello A, Fusaro E, Ditto MC, Bruzzese V, Camellino D, Bianchi G, Serale F, Foti R, Amato G, De Lucia F, Dal Bosco Y, Foti R, Reta M, Fiorenza A, Rovera G, Marchetta A, Focherini MC, Mascella F, Bernardi S, Sandri G, Giuggioli D, Salvarani C, Franchina V, Molica Colella F, Ferrero G, Ariani A. Long-Term Retention Rate of Tofacitinib in Rheumatoid Arthritis: An Italian Multicenter Retrospective Cohort Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1480. [PMID: 37629770 PMCID: PMC10456797 DOI: 10.3390/medicina59081480] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023]
Abstract
Background: Tofacitinib (TOFA) was the first Janus kinase inhibitor (JAKi) to be approved for the treatment of rheumatoid arthritis (RA). However, data on the retention rate of TOFA therapy are still far from definitive. Objective: The goal of this study is to add new real-world data on the TOFA retention rate in a cohort of RA patients followed for a long period of time. Methods: A multicenter retrospective study of RA subjects treated with TOFA as monotherapy or in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was conducted in 23 Italian tertiary rheumatology centers. The study considered a treatment period of up to 48 months for all included patients. The TOFA retention rate was assessed with the Kaplan-Meier method. Hazard ratios (HRs) for TOFA discontinuation were obtained using Cox regression analysis. Results: We enrolled a total of 213 patients. Data analysis revealed that the TOFA retention rate was 86.5% (95% CI: 81.8-91.5%) at month 12, 78.8% (95% CI: 78.8-85.2%) at month 24, 63.8% (95% CI: 55.1-73.8%) at month 36, and 59.9% (95% CI: 55.1-73.8%) at month 48 after starting treatment. None of the factors analyzed, including the number of previous treatments received, disease activity or duration, presence of rheumatoid factor and/or anti-citrullinated protein antibody, and presence of comorbidities, were predictive of the TOFA retention rate. Safety data were comparable to those reported in the registration studies. Conclusions: TOFA demonstrated a long retention rate in RA in a real-world setting. This result, together with the safety data obtained, underscores that TOFA is a viable alternative for patients who have failed treatment with csDMARD and/or biologic DMARDs (bDMARDs). Further large, long-term observational studies are urgently needed to confirm these results.
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Affiliation(s)
- Marino Paroli
- Department of Clinical, Internist, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Andrea Becciolini
- Internal Medicine and Rheumatology Unit, University Hospital of Parma, 43126 Parma, Italy; (A.B.); (E.D.D.); (G.A.); (D.S.); (G.L.); (A.A.)
| | - Elena Bravi
- Rheumatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (E.B.); (E.A.); (I.P.)
| | - Romina Andracco
- Internal Medicine Unit, Imperia Hospital, 18100 Imperia, Italy; (R.A.); (N.M.)
| | - Valeria Nucera
- Rheumatology Unit, ASL Novara, 28100 Novara, Italy; (V.N.); (A.I.)
| | - Simone Parisi
- Rheumatology Department, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (S.P.); (E.F.); (M.C.D.)
| | | | - Federica Lumetti
- Rheumatology Unit, Azienda USL of Modena and AOU Policlinico of Modena, 41100 Modena, Italy;
| | - Antonella Farina
- Internal Medicine Unit, Augusto Murri Hospital, 63900 Fermo, Italy;
| | - Patrizia Del Medico
- Internal Medicine Unit, Civitanova Marche Hospital, 62012 Civitanova Marche, Italy;
| | - Matteo Colina
- Rheumatology Unit, Internal Medicine Division, Department of Medicine and Oncology, Santa Maria della Scaletta Hospital, 40026 Imola, Italy;
- Rheumatology Unit, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy
| | | | - Viviana Ravagnani
- Rheumatology Unit, Santa Chiara Hospital APSS—Trento, 38122 Trento, Italy;
| | - Palma Scolieri
- Rheumatology Unit, Nuovo Regina Margherita Hospital, 00154 Roma, Italy; (P.S.); (V.B.)
| | - Maddalena Larosa
- Division of Rheumatology, Department of Medical Specialties, Azienda Sanitaria Locale 3 Genovese, 16132 Genova, Italy; (M.L.); (D.C.); (G.B.)
| | - Marta Priora
- Rheumatology Unit, ASL CN1, 12100 Cuneo, Italy; (M.P.); (F.S.)
| | - Elisa Visalli
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (E.V.); (R.F.); (G.A.); (F.D.L.); (Y.D.B.); (R.F.)
| | - Olga Addimanda
- Rheumatology Unit, AUSL of Bologna—Policlinico Sant’Orsola—AOU—IRCCS of Bologna, 40138 Bologna, Italy; (O.A.); (M.R.)
| | - Rosetta Vitetta
- Unit of Rheumatology, ASL VC Sant’ Andrea Hospital, 13100 Vercelli, Italy; (R.V.); (A.F.)
| | - Alessandro Volpe
- Unit of Rheumatology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, Italy; (A.V.); (A.M.)
| | - Alessandra Bezzi
- Internal Medicine and Rheumatology Unit, AUSL della Romagna—Rimini, 47924 Rimini, Italy; (A.B.); (M.C.F.); (F.M.)
| | - Francesco Girelli
- Rheumatology Unit, G.B. Morgagni—L. Pierantoni Hospital, 47121 Forlì, Italy; (F.G.); (S.B.)
| | | | - Rosalba Caccavale
- Department of Clinical, Internist, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Eleonora Di Donato
- Internal Medicine and Rheumatology Unit, University Hospital of Parma, 43126 Parma, Italy; (A.B.); (E.D.D.); (G.A.); (D.S.); (G.L.); (A.A.)
| | - Giuditta Adorni
- Internal Medicine and Rheumatology Unit, University Hospital of Parma, 43126 Parma, Italy; (A.B.); (E.D.D.); (G.A.); (D.S.); (G.L.); (A.A.)
| | - Daniele Santilli
- Internal Medicine and Rheumatology Unit, University Hospital of Parma, 43126 Parma, Italy; (A.B.); (E.D.D.); (G.A.); (D.S.); (G.L.); (A.A.)
| | - Gianluca Lucchini
- Internal Medicine and Rheumatology Unit, University Hospital of Parma, 43126 Parma, Italy; (A.B.); (E.D.D.); (G.A.); (D.S.); (G.L.); (A.A.)
| | - Eugenio Arrigoni
- Rheumatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (E.B.); (E.A.); (I.P.)
| | - Ilaria Platè
- Rheumatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (E.B.); (E.A.); (I.P.)
| | - Natalia Mansueto
- Internal Medicine Unit, Imperia Hospital, 18100 Imperia, Italy; (R.A.); (N.M.)
| | - Aurora Ianniello
- Rheumatology Unit, ASL Novara, 28100 Novara, Italy; (V.N.); (A.I.)
| | - Enrico Fusaro
- Rheumatology Department, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (S.P.); (E.F.); (M.C.D.)
| | - Maria Chiara Ditto
- Rheumatology Department, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (S.P.); (E.F.); (M.C.D.)
| | - Vincenzo Bruzzese
- Rheumatology Unit, Nuovo Regina Margherita Hospital, 00154 Roma, Italy; (P.S.); (V.B.)
| | - Dario Camellino
- Division of Rheumatology, Department of Medical Specialties, Azienda Sanitaria Locale 3 Genovese, 16132 Genova, Italy; (M.L.); (D.C.); (G.B.)
| | - Gerolamo Bianchi
- Division of Rheumatology, Department of Medical Specialties, Azienda Sanitaria Locale 3 Genovese, 16132 Genova, Italy; (M.L.); (D.C.); (G.B.)
| | | | - Rosario Foti
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (E.V.); (R.F.); (G.A.); (F.D.L.); (Y.D.B.); (R.F.)
| | - Giorgio Amato
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (E.V.); (R.F.); (G.A.); (F.D.L.); (Y.D.B.); (R.F.)
| | - Francesco De Lucia
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (E.V.); (R.F.); (G.A.); (F.D.L.); (Y.D.B.); (R.F.)
| | - Ylenia Dal Bosco
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (E.V.); (R.F.); (G.A.); (F.D.L.); (Y.D.B.); (R.F.)
| | - Roberta Foti
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (E.V.); (R.F.); (G.A.); (F.D.L.); (Y.D.B.); (R.F.)
| | - Massimo Reta
- Rheumatology Unit, AUSL of Bologna—Policlinico Sant’Orsola—AOU—IRCCS of Bologna, 40138 Bologna, Italy; (O.A.); (M.R.)
| | - Alessia Fiorenza
- Unit of Rheumatology, ASL VC Sant’ Andrea Hospital, 13100 Vercelli, Italy; (R.V.); (A.F.)
| | - Guido Rovera
- Unit of Rheumatology, ASL VC Sant’ Andrea Hospital, 13100 Vercelli, Italy; (R.V.); (A.F.)
| | - Antonio Marchetta
- Unit of Rheumatology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, Italy; (A.V.); (A.M.)
| | - Maria Cristina Focherini
- Internal Medicine and Rheumatology Unit, AUSL della Romagna—Rimini, 47924 Rimini, Italy; (A.B.); (M.C.F.); (F.M.)
| | - Fabio Mascella
- Internal Medicine and Rheumatology Unit, AUSL della Romagna—Rimini, 47924 Rimini, Italy; (A.B.); (M.C.F.); (F.M.)
| | - Simone Bernardi
- Rheumatology Unit, G.B. Morgagni—L. Pierantoni Hospital, 47121 Forlì, Italy; (F.G.); (S.B.)
| | - Gilda Sandri
- Rheumatology Unit, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.S.); (D.G.); (C.S.)
| | - Dilia Giuggioli
- Rheumatology Unit, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.S.); (D.G.); (C.S.)
| | - Carlo Salvarani
- Rheumatology Unit, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.S.); (D.G.); (C.S.)
| | - Veronica Franchina
- Medical Oncology Unit, Azienda Ospedaliera Papardo, 98158 Messina, Italy;
| | | | - Giulio Ferrero
- Unit of Diagnostic and Interventional Radiology, Santa Corona Hospital, 17027 Pietra Ligure, Italy;
| | - Alarico Ariani
- Internal Medicine and Rheumatology Unit, University Hospital of Parma, 43126 Parma, Italy; (A.B.); (E.D.D.); (G.A.); (D.S.); (G.L.); (A.A.)
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Mortezavi M, Mysler EF. Clinical scenarios-based guide for tofacitinib in rheumatoid arthritis. Ther Adv Chronic Dis 2023; 14:20406223231178273. [PMID: 37360417 PMCID: PMC10286162 DOI: 10.1177/20406223231178273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/02/2023] [Indexed: 06/28/2023] Open
Abstract
Tofacitinib was the first Janus kinase inhibitor to be approved for the treatment of rheumatoid arthritis (RA), and there is a large body of data to inform the efficacy and safety of this drug for patients at different places in their treatment journeys and with diverse demographics and characteristics. Here, we summarize tofacitinib clinical efficacy and safety data from some clinical trials, post hoc analyses, and real-world studies, which provide evidence of the efficacy of tofacitinib in treating patients with RA at various stages of their treatment journeys, and with differentiating baseline characteristics, such as age, gender, race, and body mass index. In addition, we review the safety data available from different patient subpopulations in the tofacitinib clinical development program, real-world data, and findings from the ORAL Surveillance post-marketing safety study that included patients aged ⩾50 years with pre-existing cardiovascular risk factors. The available efficacy and safety data in these subpopulations can enable better discussions between clinicians and patients to guide informed decision-making and individualized patient care.
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Movahedi M, Choquette D, Coupal L, Cesta A, Li X, Keystone EC, Bombardier C, Investigators O. Discontinuation of tofacitinib and TNF inhibitors in patients with rheumatoid arthritis: analysis of pooled data from two registries in Canada. BMJ Open 2023; 13:e063198. [PMID: 36878650 PMCID: PMC9990670 DOI: 10.1136/bmjopen-2022-063198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVES The similarity in retention of tumour necrosis factor inhibitors (TNFi) and tofacitinib (TOFA) was previously reported separately by the Ontario Best Practices Research Initiative and the Quebec cohort Rhumadata. However, because of small sample sizes in each registry, we aimed to confirm the findings by repeating the analysis of discontinuation of TNFi compared with TOFA, using pooled data from both these registries. DESIGN Retrospective cohort study. SETTING Pooled data from two rheumatoid arthritis (RA) registries in Canada. PARTICIPANTS Patients with RA starting TOFA or TNFi between June 2014 and December 2019 were included. A total of 1318 patients were included TNFi (n=825) or TOFA (n=493). OUTCOME MEASURES Time to discontinuation was assessed using Kaplan-Meier survival and Cox proportional hazards regression analysis. Propensity score (PS) stratification (deciles) and PS weighting were used to estimate treatment effects. RESULTS The mean disease duration in the TNFi group was shorter (8.9 years vs 13 years, p<0.001). Prior biological use (33.9% vs 66.9%, p<0.001) and clinical disease activity index (20.0 vs 22.1, p=0.02) were lower in the TNFi group.Discontinuation was reported in 309 (37.5%) and 181 (36.7%) TNFi and TOFA patients, respectively. After covariate adjustment using PS, there was no statistically significant difference between the two groups in discontinuation due to any reason HR=0.96 (95% CI 0.78 to 1.19, p=0.74)) as well as discontinuation due to ineffectiveness only HR=1.08 (95% CI 0.81 to 1.43, p=0.61)).TNFi users were less likely to discontinue due to adverse events (AEs) (adjusted HRs: 0.46, 95% CI 0.29 to 0.74; p=0.001). Results remained consistent for firstline users. CONCLUSIONS In this pooled real-world data study, the discontinuation rates overall were similar. However, discontinuation due to AEs was higher in TOFA compared with TNFi users.
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Affiliation(s)
- Mohammad Movahedi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- IHMPE, Univeristy of Toronto, Toronto, Ontario, Canada
| | - Denis Choquette
- Department of Rheumatology, Institut de Rhumatologie de Montréal, Montreal, Québec, Canada
| | - Louis Coupal
- Department of Rheumatology, Institut de Rhumatologie de Montréal, Montreal, Québec, Canada
| | - Angela Cesta
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Xiuying Li
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Edward C Keystone
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- IHMPE, Univeristy of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Obri Investigators
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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Tasso M, Bertolini N, Mostacciuolo E, Passavanti S, Luppino JME, Del Puente A, Peluso R, Santelli F, Scarpa R, Costa L, Caso F. Effectiveness and safety profile of tofacitinib and baricitinib in rheumatoid arthritis patients: results from a 24-month real-life prospective study in Southern-Italy. Reumatismo 2022; 74. [PMID: 36580064 DOI: 10.4081/reumatismo.2022.1511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/17/2022] [Indexed: 12/30/2022] Open
Abstract
The primary objectives of the study were to evaluate the efficacy and safety of tofacitinib and baricitinib up to 24 months of follow-up in patients with rheumatoid arthritis (RA) treated in Southern Italy. Patients' data, activity index, and clinimetric scores were collected at baseline (T0), six (T6), twelve (T12), and twenty-four (T24) months following treatment initiation. At six, twelve, and twenty-four months, adverse events and treatment cessation were also recorded. Sixty-eight patients (mean age: 62.2±10.9 years; mean RA duration: 15±9.6 years) were enrolled over a period of 12 weeks. At baseline, twenty-four patients (35.3%) were treated with tofacitinib, and forty-four patients (64.7%) were treated with baricitinib. The baseline mean disease activity was moderate as measured by DAS28- ESR (5.0±1.0), DAS 28 CRP (4.69±0.94), and SDAI (26.87±10.73) score. Before beginning JAKinhibs therapy, thirty-two patients (61.8%) were taking bDMARDs, while the remaining thirty-six (38.2%) were bDMARDs-naïve. The 24-month retention rate for JAKinhibs was 91.1%. Six months after beginning treatment with JAKinhibs, a statistically significant improvement was observed in all evaluated activity indices and clinimetric scores. Improvement was confirmed during the 12- and 24-month follow-up evaluations. The positive correlation between baseline-T6 SDAI delta and discontinuation of JAKinhibs (p=0.02) suggests that RA worsening in the first six months may be a predictor of therapy withdrawal. Patients with RA responded favorably to tofacitinib and baricitinib in this prospective, real-world study from a single center in Southern Italy. Efficacy was observed despite an underlying persistent and treatment-resistant disease.
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Affiliation(s)
- M Tasso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
| | - N Bertolini
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
| | - E Mostacciuolo
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
| | - S Passavanti
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
| | - J M E Luppino
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
| | - A Del Puente
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
| | - R Peluso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
| | - F Santelli
- Department of Political Science, University of Naples Federico II, Naples.
| | - R Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
| | - L Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
| | - F Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
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Philippoteaux C, Deprez V, Nottez A, Cailliau E, Houvenagel E, Deprez X, Philippe P, Pascart T, Flipo RM, Goëb V, Letarouilly JG. Characteristics of Patients Treated with JAK Inhibitors in Rheumatoid Arthritis before versus after VTE Risk Warnings. J Clin Med 2022; 12:jcm12010207. [PMID: 36615007 PMCID: PMC9820905 DOI: 10.3390/jcm12010207] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Baricitinib (BARI) or Tofacitinib (TOFA) were the first Janus Kinase Inhibitors (JAKi) to be marketed in rheumatoid arthritis (RA). Concerns regarding venous thromboembolism (VTE) risk have emerged during the past years. The aim of the study was to compare the baseline characteristics of patients initiating BARI or TOFA in RA before versus after European Medicine Agency (EMA)'s VTE warnings and to compare real-world persistence with these two drugs. METHODS In this multicentric cohort study, RA patients initiating BARI or TOFA were included from October 2017, date of BARI marketing authorization in France, to September 2020. Baseline characteristics regarding VTE risk were compared (before vs. after May 2019) by using pre-specified statistical tests. Comparison of persistence was assessed by using propensity-score methods. RESULTS 232 patients were included; 155 with BARI and 77 with TOFA. Baseline characteristics of patients regarding VTE risk factors were not statistically different when Janus Kinase inhibitor (JAKi) was initiated before vs. after EMA's warnings although a trend towards a lower proportion of VTE history was observed. Five VTE events occurred, four with BARI, one with TOFA. Cumulative persistence rate at 2 years was similar between BARI and TOFA: HR 0.96; 95% Cl: 0.52 to 1.74; p = 0.89. CONCLUSIONS Our study did not show a significant change in patients characteristics starting a JAKi after the EMA's warnings, probably due to a lack of power. Though, the lower proportion of VTE history in patients after May 2019 suggests that rheumatologists have taken into account the potential VTE risk. These results need to be confirmed by further evidence.
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Affiliation(s)
- Cécile Philippoteaux
- Department of Rheumatology, Lille University Hospital, 59000 Lille, France
- Correspondence:
| | - Valentine Deprez
- Department of Rheumatology, Amiens University Hospital, 80000 Amiens, France
| | - Aurore Nottez
- Department of Rheumatology, Dunkerque Hospital, 59240 Dunkerque, France
| | - Emeline Cailliau
- Department of Biostatistics, Lille University Hospital, 59000 Lille, France
- ULR 2694—METRICS: Evaluation of Health Technologies and Medical Practices, Lille University, 59000 Lille, France
| | - Eric Houvenagel
- Department of Rheumatology, Catholic Saint Philibert Hospital, 59160 Lomme, France
| | - Xavier Deprez
- Department of Rheumatology, Valenciennes Hospital, 59300 Valenciennes, France
| | - Peggy Philippe
- Department of Rheumatology, Lille University Hospital, 59000 Lille, France
| | - Tristan Pascart
- Department of Rheumatology, Catholic Saint Philibert Hospital, 59160 Lomme, France
| | - René-Marc Flipo
- Department of Rheumatology, Lille University Hospital, 59000 Lille, France
| | - Vincent Goëb
- Department of Rheumatology, Amiens University Hospital, 80000 Amiens, France
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González Mazarío R, Fragío Gil JJ, Ivorra Cortés J, Grau García E, Cañada Martínez AJ, González Puig L, Negueroles Albuixech RM, Román Ivorra JA. Real-world Effectiveness and Safety of JAK Inhibitors in Rheumatoid Arthritis: A Single-centre Study. REUMATOLOGIA CLINICA 2022; 18:523-530. [PMID: 36309409 DOI: 10.1016/j.reumae.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/02/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND/OBJECTIVE To assess the effectiveness and safety of Baricitinib and Tofacitinib in rheumatoid arthritis (RA) patients in "real world" conditions. METHODS A single centre retrospective study was performed including RA patients who had initiated treatment with Baricitinib or Tofacitinib from September-2017 to January-2020. Demographic, clinical, laboratory, efficacy and safety variables were collected from baseline and at months 1, 3, 6, 12, 18 and 24. Effectiveness was evaluated by changes from the baseline in DAS28, SDAI, HAQ and acute phase reactants. Safety analysis included adverse events due to any cause, including infection or intolerance. Infection was considered severe if it implied hospitalization. Statistical analysis consisted in Bayesian mixed ordinal regression models including the monotonic effect of each visit and Kaplan-Meier survival curves. RESULTS Overall, 98 patients were included. A significant reduction of disease activity scores was noted in both groups. No difference between either treatment was detected in terms of effectiveness even in first line, after bDMARD failure, in monotherapy nor combined therapy. A total of 54 adverse events were recorded of which 18 were considered relevant. The incidence of infection, including Herpes Zoster, was similar in both groups. No patients in either group suffered any tuberculosis, thromboembolic event, malignancy, death or cardiovascular adverse events. Survival analysis did not show any difference between groups. CONCLUSION Baricitinib and Tofacitinib are both comparable in terms of effectiveness and safety in real world conditions.
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Affiliation(s)
- Roxana González Mazarío
- Servicio de Reumatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir (UCV), Valencia, Spain
| | - Jorge Juan Fragío Gil
- Servicio de Reumatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir (UCV), Valencia, Spain; Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain.
| | - José Ivorra Cortés
- Servicio de Reumatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Elena Grau García
- Servicio de Reumatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | | | - Luis González Puig
- Servicio de Reumatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - José Andrés Román Ivorra
- Servicio de Reumatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir (UCV), Valencia, Spain
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12
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Sedeh FB, Henning MAS, Jemec GBE, Ibler KS. Comparative Efficacy and Safety of Monoclonal Antibodies and Janus Kinase Inhibitors in Moderate-to-severe Atopic Dermatitis: A Systematic Review and Meta-analysis. Acta Derm Venereol 2022; 102:adv00764. [PMID: 35818735 PMCID: PMC9574696 DOI: 10.2340/actadv.v102.2075] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to compare the efficacies of systemic treatments with dupilumab, tralokinumab and Janus kinase inhibitors for moderate-to-severe atopic dermatitis. A systematic review following Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines was performed using Medline, EMBASE and Cochrane library. All randomized controlled trials investigating the efficacy of systemic treatments for moderate-to-severe atopic dermatitis in adults were included. Primary outcomes were the proportion of patients with atopic dermatitis achieving 50%, 75%, and 90% improvement in Eczema Area and Severity Index (EASI) score after dupilumab, tralokinumab or Janus kinase inhibitors. Nineteen studies totalling 6,444 patients were included. In monotherapy studies, upadacitinib 30 mg once daily had the numerically highest efficacy regarding EASI-50, EASI-75 and EASI-90. In combination therapy studies with topical corticosteroids, dupilumab 300 mg once every other week had highest efficacy regarding EASI-50, and abrocitinib 200 mg once daily had the highest score regarding EASI-75 and EASI-90. Analysis provided evidence that dupilumab, tralokinumab and Janus kinase inhibitors all had an acceptable efficacy profile and resulted in clinically relevant improvements in EASI score. Furthermore, upadacitinib and abrocitinib seem to have great potential to treat patients with atopic dermatitis. However, further studies are needed to determine the long-term efficacy of Janus kinase inhibitors in adults with moderate-to-severe atopic dermatitis.
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Affiliation(s)
- Farnam B Sedeh
- Department of Dermato-venereology, Zealand University Hospital, Roskilde, Denmark.
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Phatak S, Khenat A, Malandkar M, Amin S. Real-world evidence of the effectiveness and safety of generic tofacitinib in rheumatoid arthritis patients: a retrospective, single-centre analysis from Western India. Clin Rheumatol 2022; 41:2961-2966. [PMID: 35596818 PMCID: PMC9123831 DOI: 10.1007/s10067-022-06205-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/28/2022] [Accepted: 05/08/2022] [Indexed: 12/03/2022]
Abstract
Generic tofacitinib has been available in India for more than a year and is widely used in rheumatoid arthritis (RA) therapy. There is scarce real-world data on its effectiveness and safety from India, especially given infection endemicity. We retrospectively analysed records (demographic and clinical information, haematology and biochemistry, adverse events) of patients prescribed generic tofacitinib from a single centre in Mumbai, India. Disease activity was calculated using the disease activity score-28 and erythrocyte sedimentation rate (DAS28-ESR) and other tools, and we used paired T-tests for significant response. We defined clinical tofacitinib failure as a composite outcome, including clinician’s decision to change to an alternative disease-modifying anti-rheumatic drug (DMARD) or flare after self-withdrawal. We performed logistic regression and survival analysis for determinants of clinical failure. We reviewed records of 102 patients (92 female; median age: 53 years) with mean RA duration of 146 months. Thirteen had prior treatment with innovator tofacitinib. There was significant improvement in disease activity parameters at a mean duration of 186 days. No serious adverse events were reported; 4 patients had tuberculosis and 19 patients had mild COVID-19 while on treatment. Clinical failure was seen in 25 patients, and mean time to failure on survival analysis was 357 days. No baseline characteristic predicted clinical failure. Generic tofacitinib showed good effectiveness and a tolerable adverse effect profile, despite tuberculosis endemicity and COVID-19. Setting up registries would be valuable in gaining more data on generic tofacitinib.Key Points • There is scarce data from India regarding the use of tofacitinib in rheumatoid arthritis, despite widespread use. • In this retrospective analysis of 102 patients at a single centre, we found tofacitinib monotherapy was efficacious and tolerable. • Tuberculosis was detected in four and nineteen patients had mild covid. |
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Affiliation(s)
- Sanat Phatak
- KEM Hospital Research Centre, Sardar Moodliar Road, Pune, 411011, India. .,BJ Medical College and Sassoon General Hospital, Pune, India.
| | - Aditya Khenat
- BJ Medical College and Sassoon General Hospital, Pune, India
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Román Ivorra JA, Llevat N, Montoro M. Real-world evidence of tofacitinib in rheumatoid arthritis patients in Spain. Drug Discov Ther 2022; 16:63-71. [PMID: 35491233 DOI: 10.5582/ddt.2022.01028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this narrative review is to provide an overview of the real-world data on the use of tofacitinib in patients with active rheumatoid arthritis (RA) in Spain. Sixteen retrospective studies carried out in Spain between 2019 and 2021 have been analyzed, considering patients' characteristics, and treatment patterns, effectiveness, and safety. In those studies, approximately 511 patients received tofacitinib during the study period. They were predominantly women (mean age: 48-61 years). The percentage of patients receiving tofacitinib as monotherapy ranged between 20.0% and 67.9%. Only five studies reported the combined use of corticosteroids (42.0-84.5% of patients), with a mean dose varying from 1.8 to 7.2 mg. A wide range of patients (36.0-85.7%) had failed a previous biological disease-modifying anti-rheumatic drug. The most frequent reason for treatment discontinuation was the lack of efficacy, and the most common adverse event described was herpes zoster infection. Real-world studies complement clinical trials by adding efficacy and safety data in real-world settings to the benefit/risk profile of the drug. The profile of RA patients receiving tofacitinib in Spain has similarities with other real-world studies conducted in other countries.
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Affiliation(s)
- José A Román Ivorra
- Rheumatology Department, Hospital Universitari i Politècnic La Fe. Valencia. Facultad de Medicina y Ciencias de la Salud. Universidad Católica de Valencia, Spain
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15
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Dikranian A, Gold D, Bessette L, Nash P, Azevedo VF, Wang L, Woolcott J, Shapiro AB, Szumski A, Fleishaker D, Wollenhaupt J. Frequency and Duration of Early Non-serious Adverse Events in Patients with Rheumatoid Arthritis and Psoriatic Arthritis Treated with Tofacitinib. Rheumatol Ther 2022; 9:411-433. [PMID: 34921355 PMCID: PMC8964869 DOI: 10.1007/s40744-021-00405-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/17/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA) and psoriatic arthritis (PsA). This post hoc analysis assessed frequency or duration of early select non-serious adverse events (AEs; excluding infections), and their impact on treatment discontinuation, in patients with RA or PsA treated with tofacitinib 5 or 10 mg twice daily, or placebo. METHODS Data were pooled from five phase 3 and one phase 3b/4 studies in patients with moderate-to-severe RA, and two phase 3 studies in patients with active PsA. Select all-causality, non-serious AEs, reported to month 3 (placebo-controlled period), were headache, diarrhea, nausea, vomiting, and gastric discomfort (including dyspepsia, gastritis, epigastric discomfort, and abdominal discomfort or pain); incidence rates (unique patients with events per 100 patient-years of follow-up), duration of, and discontinuations due to these non-serious AEs were reported. RESULTS We analyzed 3871 and 710 patients with RA and PsA, respectively. Incidence of non-serious AEs to month 3 was generally similar with tofacitinib and placebo. The most frequent non-serious AEs were headache and diarrhea with tofacitinib, and dyspepsia, nausea, and headache with placebo. Most events were mild or moderate in severity, lasting ≤ 4 weeks. Permanent discontinuations due to non-serious AEs were not observed in patients with PsA, and were < 1.0% in patients with RA across treatment groups. The most frequent cause of temporary discontinuation across all groups was gastric discomfort (0.3-0.8%). CONCLUSIONS Non-serious AE incidence was generally similar in patients with RA or PsA receiving tofacitinib or placebo. Most events were mild or moderate and generally resolved within 4 weeks. TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT00960440; NCT00847613; NCT00814307; NCT00856544; NCT00853385; NCT01877668; NCT01882439; NCT02187055.
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Affiliation(s)
- Ara Dikranian
- Cabrillo Center for Rheumatic Disease, 5030 Camino de la Siesta, Suite 106, San Diego, CA, 92108, USA.
| | | | | | - Peter Nash
- Griffith University, Brisbane, Australia
| | | | | | | | | | | | | | - Jürgen Wollenhaupt
- Rheumatologie Struenseehaus, Center for Arthritis and Immunology, Hamburg, Germany
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Sundbaum JK, Baecklund E, Eriksson N, Kohnke H, Wallenberg M, Cavalli M, Wadelius C, Wadelius M, Hallberg P. Genome-wide association study of liver enzyme elevation in rheumatoid arthritis patients starting methotrexate. Pharmacogenomics 2021; 22:973-982. [PMID: 34521259 DOI: 10.2217/pgs-2021-0064] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: To identify novel genetic variants predisposing to elevation of Alanine aminotransferase (ALT) in rheumatoid arthritis (RA) patients after initiation of methotrexate (MTX) treatment. Patients & methods: We performed genome-wide association studies in 198 RA patients starting MTX. Outcomes were maximum level of ALT and ALT >1.5-times the upper level of normal within the first 6 months of treatment. Results: RAVER2 (rs72675408) was significantly associated with maximum level of ALT (p = 4.36 × 10-8). This variant is in linkage disequilibrium with rs72675451, which is associated with differential expression of JAK1 and RAVER2. Conclusion: We found an association between ALT elevation and genetic variants that may regulate the expression of JAK1 and RAVER2. JAK1 encodes a janus kinase involved in the pathogenesis of RA.
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Affiliation(s)
- Johanna Karlsson Sundbaum
- Department of Medical Sciences, Rheumatology, Uppsala University, SE-751 85, Uppsala, Sweden.,Department of Health Sciences, Luleå University of Technology, SE-971 87, Luleå, Sweden
| | - Eva Baecklund
- Department of Medical Sciences, Rheumatology, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Niclas Eriksson
- Uppsala Clinical Research center, SE-751 85, Uppsala, Sweden.,Department of Medical Sciences, Clinical Pharmacogenomics & Science for Life Laboratory, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Hugo Kohnke
- Department of Medical Sciences, Clinical Pharmacogenomics & Science for Life Laboratory, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Matilda Wallenberg
- Department of Medical Sciences, Clinical Pharmacogenomics & Science for Life Laboratory, Uppsala University, SE-751 85, Uppsala, Sweden.,Svensk Dos AB, Box 2, SE-751 03, Uppsala, Sweden
| | - Marco Cavalli
- Department of Immunology, Genetics & Pathology, & Science for Life Laboratory, Uppsala University, SE-751 22, Uppsala, Sweden
| | - Claes Wadelius
- Department of Immunology, Genetics & Pathology, & Science for Life Laboratory, Uppsala University, SE-751 22, Uppsala, Sweden
| | - Mia Wadelius
- Department of Medical Sciences, Clinical Pharmacogenomics & Science for Life Laboratory, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Pär Hallberg
- Department of Medical Sciences, Clinical Pharmacogenomics & Science for Life Laboratory, Uppsala University, SE-751 85, Uppsala, Sweden
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17
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Mori S, Urata Y, Yoshitama T, Ueki Y. Tofacitinib versus tocilizumab in the treatment of biological-naïve or previous biological-failure patients with methotrexate-refractory active rheumatoid arthritis. RMD Open 2021; 7:rmdopen-2021-001601. [PMID: 33958440 PMCID: PMC8103932 DOI: 10.1136/rmdopen-2021-001601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/13/2021] [Accepted: 04/22/2021] [Indexed: 01/11/2023] Open
Abstract
Objectives To compare effectiveness between tofacitinib and tocilizumab treatments for biological disease-modifying antirheumatic drug (bDMARD)-naïve patients or previous bDMARD-failure patients with active rheumatoid arthritis (RA) refractory to methotrexate (MTX). Methods We used two ongoing real-world registries of patients with RA who had first started tofacitinib or tocilizumab between August 2013 and February 2019 at our institutions. Clinical disease activity index (CDAI)-based improvements at 12 months were used for comparisons between tofacitinib and tocilizumab treatments, separately for bDMARD-naïve and previous bDMARD-failure patients. Results A total of 464 patients with RA with high or moderate CDAI were enrolled (247 with tofacitinib and 217 with tocilizumab). After adjustments for treatment-selection bias by propensity score matching, we showed that tofacitinib was more likely to induce and maintain ≥85% improvement in CDAI (CDAI85), CDAI70 and remission at 12 months compared with tocilizumab in bDMARD-naïve patients. After adjusting for concurrent use of MTX and prednisolone, the ORs of tofacitinib versus tocilizumab were 3.88 (95% CI 1.87 to 8.03) for CDAI85, 2.89 (95% CI 1.43 to 5.84) for CDAI70 and 3.31 (95% CI 1.69 to 6.48) for remission. These effects were not observed in bDMARD-failure patients. In tofacitinib treatment for bDMARD-failure patients, the number of previously failed bDMARD classes was not associated with CDAI-based improvements. The rate of overall adverse events was similar between both treatments. Similar ORs were obtained from patients adjusted by inverse probability of treatment weighting. Conclusions Compared with tocilizumab, tofacitinib can induce greater improvements during the first 12-month treatment in bDMARD-naïve patients, but this difference was not observed in previous bDMARD-failure patients.
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Affiliation(s)
- Shunsuke Mori
- Rheumatology, National Hospital Organisation Kumamoto Saishun Medical Center, Koshi, Japan
| | - Yukitomo Urata
- Rheumatology, Tsugaru General Hospital United Municipalities of Tsugaru, Goshogawara, Japan
| | - Tamami Yoshitama
- Rheumatology, Yoshitama Clinic for Rheumatic Diseases, Kirishima, Japan
| | - Yukitaka Ueki
- Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, Sasebo, Japan
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18
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Bertoldi I, Caporali R. Tofacitinib: Real-World Data and Treatment Persistence in Rheumatoid Arthritis. Open Access Rheumatol 2021; 13:221-237. [PMID: 34349573 PMCID: PMC8326925 DOI: 10.2147/oarrr.s322086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/15/2021] [Indexed: 12/25/2022] Open
Abstract
Tofacitinib is an oral Janus kinase (JAK) inhibitor indicated for the treatment of rheumatoid arthritis (RA). The efficacy and safety/tolerability of tofacitinib have been extensively evaluated as monotherapy and combination therapy in multiple, randomised, multicentre studies in patients with RA. Tofacitinib as monotherapy (as first- and second-line treatment) or as combination with methotrexate (MTX) or other csDMARDs as second- and third-line treatment is effective and generally well tolerated in patients with RA. This article focuses on recent real-world evidence investigating the effectiveness, treatment persistence and safety/tolerability of tofacitinib in patients with RA. With this purpose, a literature review was conducted from April 2018 up to October 2020 for the effectiveness, persistence and safety of tofacitinib for the treatment of RA, primarily focusing on real-world studies. These retrospective and prospective and observational studies demonstrate the effectiveness of tofacitinib, thus supporting pivotal data from the clinical trial programme. Treatment persistence was generally comparable to that of biologic disease-modifying anti-rheumatic drugs. Safety findings in these observational studies were consistent with the known safety profile of the approved dose of 5 mg twice daily.
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Affiliation(s)
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan and ASST Pini-CTO Hospital, Milan, Italy
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19
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BİLGİN E, CEYLAN F, DURAN E, FARİSOĞULLARI B, BÖLEK EÇ, YARDIMCI GK, KILIÇ L, AKDOĞAN A, KARADAĞ Ö, BİLGEN ŞA, KİRAZ S, ERTENLİ Aİ, KALYONCU U. Efficacy, retention, and safety of tofacitinib in real-life: Hur-bio monocentric experience. Turk J Med Sci 2021; 51:297-308. [PMID: 32979899 PMCID: PMC7991862 DOI: 10.3906/sag-2007-123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/26/2020] [Indexed: 12/11/2022] Open
Abstract
Background/aim To assess the real-life efficacy, retention rate, and safety data of tofacitinib in rheumatoid arthritis (RA) patients. Materials and methods We analyzed all patients registered in the HURBİO database who received at least 1 dose of tofacitinib. Patients who received at least one dose were included in retention analysis; patients with at least 1 control visit were included in efficacy and safety analysis. Factors predicting good response at the last follow-up visit were analyzed by logistic regression analysis. Drug retention rates were calculated using the Kaplan–Meier method and predictors of drug retention were determined by Cox proportional hazard model. Adverse events, reasons for switching, and discontinuation were also determined. Results Two hundred and forty-seven (210, 85.0% female) patients were included in the study. The median duration of tofacitinib treatment was 10.2 (20.2) [med, (IQR)] months. Two hundred and four (82.6%) patients were included in safety and efficacy analysis; 45.6% of patients were in low-disease activity (LDA) state (DAS28-CRP ≤ 3.2). Predictors of LDA were being biologic-naïve [aOR 2.53 (1.31–4.88); 95% CI] and RF negativity [aOR 2.14 (1.12–4.07); 95% CI]. At 1 year, the overall tofacitinib retention rate was 63.9% with no relevant predicting factor. Response and retention rates of tofacitinib were similar in patients with and without concomitant csDMARDs. Treatment failure was the most common cause of discontinuation. The most common infectious and laboratory adverse events were herpes zoster infection (3.9 per 100 patient-years) and elevation in ALT (x3UNL: 9.7 per 100 patient-years), respectively. Conclusion Tofacitinib is effective as monotherapy or in combination with csDMARDs. It is a well-tolerated treatment option in Turkish RA patients.
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Affiliation(s)
- Emre BİLGİN
- Division of Rheumatology, Department of Internal Medicine, Medical School of Hacettepe University, AnkaraTurkey
| | - Furkan CEYLAN
- Department of Internal Medicine, Medical School of Hacettepe University, AnkaraTurkey
| | - Emine DURAN
- Division of Rheumatology, Department of Internal Medicine, Medical School of Hacettepe University, AnkaraTurkey
| | - Bayram FARİSOĞULLARI
- Division of Rheumatology, Department of Internal Medicine, Medical School of Hacettepe University, AnkaraTurkey
| | - Ertuğrul Çağrı BÖLEK
- Division of Rheumatology, Department of Internal Medicine, Medical School of Hacettepe University, AnkaraTurkey
| | - Gözde Kübra YARDIMCI
- Division of Rheumatology, Department of Internal Medicine, Medical School of Hacettepe University, AnkaraTurkey
| | - Levent KILIÇ
- Division of Rheumatology, Department of Internal Medicine, Medical School of Hacettepe University, AnkaraTurkey
| | - Ali AKDOĞAN
- Division of Rheumatology, Department of Internal Medicine, Medical School of Hacettepe University, AnkaraTurkey
| | - Ömer KARADAĞ
- Division of Rheumatology, Department of Internal Medicine, Medical School of Hacettepe University, AnkaraTurkey
| | - Şule Apraş BİLGEN
- Division of Rheumatology, Department of Internal Medicine, Medical School of Hacettepe University, AnkaraTurkey
| | - Sedat KİRAZ
- Division of Rheumatology, Department of Internal Medicine, Medical School of Hacettepe University, AnkaraTurkey
| | - Ali İhsan ERTENLİ
- Division of Rheumatology, Department of Internal Medicine, Medical School of Hacettepe University, AnkaraTurkey
| | - Umut KALYONCU
- Division of Rheumatology, Department of Internal Medicine, Medical School of Hacettepe University, AnkaraTurkey
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20
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Nash P, Kerschbaumer A, Dörner T, Dougados M, Fleischmann RM, Geissler K, McInnes I, Pope JE, van der Heijde D, Stoffer-Marx M, Takeuchi T, Trauner M, Winthrop KL, de Wit M, Aletaha D, Baraliakos X, Boehncke WH, Emery P, Isaacs JD, Kremer J, Lee EB, Maksymowych WP, Voshaar M, Tam LS, Tanaka Y, van den Bosch F, Westhovens R, Xavier R, Smolen JS. Points to consider for the treatment of immune-mediated inflammatory diseases with Janus kinase inhibitors: a consensus statement. Ann Rheum Dis 2021; 80:71-87. [PMID: 33158881 PMCID: PMC7788060 DOI: 10.1136/annrheumdis-2020-218398] [Citation(s) in RCA: 155] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Janus kinase inhibitors (JAKi) have been approved for use in various immune-mediated inflammatory diseases. With five agents licensed, it was timely to summarise the current understanding of JAKi use based on a systematic literature review (SLR) on efficacy and safety. METHODS Existing data were evaluated by a steering committee and subsequently reviewed by a 29 person expert committee leading to the formulation of a consensus statement that may assist the clinicians, patients and other stakeholders once the decision is made to commence a JAKi. The committee included patients, rheumatologists, a gastroenterologist, a haematologist, a dermatologist, an infectious disease specialist and a health professional. The SLR informed the Task Force on controlled and open clinical trials, registry data, phase 4 trials and meta-analyses. In addition, approval of new compounds by, and warnings from regulators that were issued after the end of the SLR search date were taken into consideration. RESULTS The Task Force agreed on and developed four general principles and a total of 26 points for consideration which were grouped into six areas addressing indications, treatment dose and comedication, contraindications, pretreatment screening and risks, laboratory and clinical follow-up examinations, and adverse events. Levels of evidence and strengths of recommendations were determined based on the SLR and levels of agreement were voted on for every point, reaching a range between 8.8 and 9.9 on a 10-point scale. CONCLUSION The consensus provides an assessment of evidence for efficacy and safety of an important therapeutic class with guidance on issues of practical management.
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Affiliation(s)
- Peter Nash
- School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Andreas Kerschbaumer
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas Dörner
- Dept. Med./Rheumatology and Clinical Immunology, Charite Univ. Hospital, Berlin, Germany
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France
| | - Roy M Fleischmann
- Department of Medicine, Southwestern University of Texas, Dallas, Texas, USA
| | | | - Iain McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Janet E Pope
- Medicine, Division of Rheumatology, The University of Western Ontario, London, Ontario, Canada
| | | | - Michaela Stoffer-Marx
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | | | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | | | - Maarten de Wit
- Medical Humanities, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, 1090 Vienna, Austria
| | | | | | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - John D Isaacs
- Musculoskeletal Research Group, Newcastle University, Newcastle upon Tyne, UK
| | - Joel Kremer
- Rheumatology, Albany Medical College, Albany, New York, USA
| | - Eun Bong Lee
- Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Walter P Maksymowych
- Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Marieke Voshaar
- Medical Humanities, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Lai-Shan Tam
- Department of Medicine & Therapeutics, Chinese University of Hong Kong Shaw College, New Territories, Hong Kong
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | | | | | - Ricardo Xavier
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, 1090 Vienna, Austria
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21
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Nash P, Kerschbaumer A, Dörner T, Dougados M, Fleischmann RM, Geissler K, McInnes I, Pope JE, van der Heijde D, Stoffer-Marx M, Takeuchi T, Trauner M, Winthrop KL, de Wit M, Aletaha D, Baraliakos X, Boehncke WH, Emery P, Isaacs JD, Kremer J, Lee EB, Maksymowych WP, Voshaar M, Tam LS, Tanaka Y, van den Bosch F, Westhovens R, Xavier R, Smolen JS. Points to consider for the treatment of immune-mediated inflammatory diseases with Janus kinase inhibitors: a consensus statement. Ann Rheum Dis 2021. [PMID: 33158881 DOI: 10.1136/annrheumdis2020-218580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Janus kinase inhibitors (JAKi) have been approved for use in various immune-mediated inflammatory diseases. With five agents licensed, it was timely to summarise the current understanding of JAKi use based on a systematic literature review (SLR) on efficacy and safety. METHODS Existing data were evaluated by a steering committee and subsequently reviewed by a 29 person expert committee leading to the formulation of a consensus statement that may assist the clinicians, patients and other stakeholders once the decision is made to commence a JAKi. The committee included patients, rheumatologists, a gastroenterologist, a haematologist, a dermatologist, an infectious disease specialist and a health professional. The SLR informed the Task Force on controlled and open clinical trials, registry data, phase 4 trials and meta-analyses. In addition, approval of new compounds by, and warnings from regulators that were issued after the end of the SLR search date were taken into consideration. RESULTS The Task Force agreed on and developed four general principles and a total of 26 points for consideration which were grouped into six areas addressing indications, treatment dose and comedication, contraindications, pretreatment screening and risks, laboratory and clinical follow-up examinations, and adverse events. Levels of evidence and strengths of recommendations were determined based on the SLR and levels of agreement were voted on for every point, reaching a range between 8.8 and 9.9 on a 10-point scale. CONCLUSION The consensus provides an assessment of evidence for efficacy and safety of an important therapeutic class with guidance on issues of practical management.
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Affiliation(s)
- Peter Nash
- School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Andreas Kerschbaumer
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas Dörner
- Dept. Med./Rheumatology and Clinical Immunology, Charite Univ. Hospital, Berlin, Germany
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France
| | - Roy M Fleischmann
- Department of Medicine, Southwestern University of Texas, Dallas, Texas, USA
| | | | - Iain McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Janet E Pope
- Medicine, Division of Rheumatology, The University of Western Ontario, London, Ontario, Canada
| | | | - Michaela Stoffer-Marx
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | | | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | | | - Maarten de Wit
- Medical Humanities, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, 1090 Vienna, Austria
| | | | | | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - John D Isaacs
- Musculoskeletal Research Group, Newcastle University, Newcastle upon Tyne, UK
| | - Joel Kremer
- Rheumatology, Albany Medical College, Albany, New York, USA
| | - Eun Bong Lee
- Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Walter P Maksymowych
- Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Marieke Voshaar
- Medical Humanities, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Lai-Shan Tam
- Department of Medicine & Therapeutics, Chinese University of Hong Kong Shaw College, New Territories, Hong Kong
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | | | | | - Ricardo Xavier
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, 1090 Vienna, Austria
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22
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Krishna V, Yin X, Song Q, Walsh A, Pocalyko D, Bachman K, Anderson I, Madakamutil L, Nagpal S. Integration of the Transcriptome and Genome-Wide Landscape of BRD2 and BRD4 Binding Motifs Identifies Key Superenhancer Genes and Reveals the Mechanism of Bet Inhibitor Action in Rheumatoid Arthritis Synovial Fibroblasts. THE JOURNAL OF IMMUNOLOGY 2020; 206:422-431. [PMID: 33288543 DOI: 10.4049/jimmunol.2000286] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 11/10/2020] [Indexed: 12/21/2022]
Abstract
Fibroblast-like synoviocytes (FLS), one of the main cell types of the rheumatoid arthritis (RA) synovium, possess phenotypic and molecular characteristics of transformed cells. JQ1, an inhibitor of the bromodomain and extra terminal domain family that includes BRD2, BRD3, BRD4, and BRDt, has shown efficacy in models of arthritis. We demonstrate that the active isomer of JQ1 but not its inactive isomer inhibits IL-1β-induced RA-FLS activation and proliferation. To understand the mechanism of JQ1 action, we subjected JQ1-treated RA-FLS to transcriptional profiling and determined BRD2 and BRD4 cistromes by identifying their global chromatin binding sites. In addition, assay for transposable accessible chromatin by high throughput sequencing was employed to identify open and closed regions of chromatin in JQ1-treated RA-FLS. Through an integrated analysis of expression profiling, Brd2/Brd4 cistrome data, and changes in chromatin accessibility, we found that JQ1 inhibited key BRD2/BRD4 superenhancer genes, downregulated multiple crucial inflammatory pathways, and altered the genome-wide occupancy of critical transcription factors involved in inflammatory signaling. Our results suggest a pleiotropic effect of JQ1 on pathways that have shown to be individually efficacious in RA (in vitro, in vivo, and/or in humans) and provide a strong rationale for targeting BRD2/BRD4 for disease treatment and interception.
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Affiliation(s)
- Vinod Krishna
- Discovery Sciences, Janssen Research and Development, Spring House, PA 19477; and
| | - Xuefeng Yin
- Discovery Immunology, Janssen Research and Development, Spring House, PA 19477
| | - Qingxuan Song
- Discovery Immunology, Janssen Research and Development, Spring House, PA 19477
| | - Alice Walsh
- Discovery Immunology, Janssen Research and Development, Spring House, PA 19477
| | - David Pocalyko
- Discovery Sciences, Janssen Research and Development, Spring House, PA 19477; and
| | - Kurtis Bachman
- Discovery Sciences, Janssen Research and Development, Spring House, PA 19477; and
| | - Ian Anderson
- Discovery Immunology, Janssen Research and Development, Spring House, PA 19477
| | - Loui Madakamutil
- Discovery Immunology, Janssen Research and Development, Spring House, PA 19477
| | - Sunil Nagpal
- Discovery Immunology, Janssen Research and Development, Spring House, PA 19477
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23
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Update on the Safety Profile of Tofacitinib in Rheumatoid Arthritis from Clinical Trials to Real-World Studies: A Narrative Review. Rheumatol Ther 2020; 8:17-40. [PMID: 33245555 PMCID: PMC7991042 DOI: 10.1007/s40744-020-00258-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/11/2020] [Indexed: 12/11/2022] Open
Abstract
Tofacitinib is approved for the treatment of moderate to severe active rheumatoid arthritis (RA) in adult patients who do not respond adequately or are intolerant to one or more disease-modifying anti-rheumatic drugs. The tofacitinib RA clinical development program included randomized controlled trials of 6–24-month duration and long-term extension studies with > 7061 patients and 22,875 patient-years of exposure. To date, there are no data from other randomized studies in patients with cardiovascular risk factors comparing the long-term safety of a JAK inhibitor versus an anti-TNF. Real-world studies are necessary to complete the body of evidence supporting the effectiveness and safety of a therapeutic agent. In the case of tofacitinib, real-world data derive from health insurance claims databases, registries (US Corrona Registry, Swiss Registry, and others), national pharmacovigilance programs, and hospital databases (case series). The present article provides complete and up-to-date information on the safety profile of tofacitinib in RA, from clinical trials to real-world studies. Tofacitinib has demonstrated a consistent safety profile during up to 9.5 years of experience in randomized controlled trials and long-term extension studies. Real-world evidence has not added new safety issues with respect to those found in the clinical program. In general, the safety profile of tofacitinib is consistent with that of biologic disease-modifying anti-rheumatic drugs, with an increased risk of herpes zoster that seems to be a class effect of Janus kinase inhibitors. The continuous follow-up of therapeutic agents to treat rheumatoid arthritis is needed to adequately establish the safety profile for new mechanisms of action and potential risks associated with their longer term use.
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24
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Sharma E, Meade S, D’Errico F, Pavlidis P, Luber R, Zeki S, Hill K, Duff A, O’Hanlon D, Tripoli S, Stanton A, Caracostea A, Honap S, Reynolds R, Anderson S, Ray S, Mawdsley J, Sanderson J, Samaan MA, Irving PM. The effects of COVID-19 on IBD prescribing and service provision in a UK tertiary centre. GASTROHEP 2020; 2:318-326. [PMID: 33362435 PMCID: PMC7753474 DOI: 10.1002/ygh2.433] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND To quantify the effects of COVID-19 on our inflammatory bowel disease (IBD) unit, including service provision, prescribing practices and use of therapeutic drug monitoring (TDM). METHODS We performed a single centre retrospective observational cohort study. Data was extracted from our IBD database, electronic patient records and radiology/endoscopy reporting systems between 16/3/20-17/4/20 and the corresponding period in 2019. RESULTS A similar number of patients commenced biologic therapy before COVID-19 (n = 37) and during the pandemic (n = 36). Patients in the pre-COVID-19 cohort were older (median 36 vs 29 years, P = 0.009) with a longer median disease duration (9.3 vs 5.2 years, P = 0.02). During COVID-19 there was a nonsignificant increase in prescribing of vedolizumab (8/37, 22% vs 14/36, 39%, P = 0.13) and a higher proportion of patients were anti-TNF-naïve (3/17, 18% vs 18/24, 74%, P = 0.0004). There was a reduction in use of concomitant immunomodulators (22/29, 76% vs 4/34, 12%, P < 0.0001) and increased biologic use in thiopurine-naïve patients (3/37, 8% vs 15/36, 42%, P = 0.001). Use of TDM fell by 75% (240 vs 59 tests). Outpatient appointments fell by 68% and were conducted via telemedicine. MRI scanning, endoscopy, luminal surgery and inpatient numbers fell by 87%, 85%, 100% and 82% respectively. IBD Clinical Nurse Specialist and Pharmacist helpline contacts increased by 76% and 228% respectively. CONCLUSIONS We observed prescribing differences during COVID-19, bypassing the initiation of immunomodulators and/or anti-TNF therapy in favour of vedolizumab with a reduction in immunomodulator prescribing. We also observed a rapid reorganisation of service provision, including a shift towards telemedicine and online solutions.
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Affiliation(s)
- Esha Sharma
- Inflammatory Bowel Disease UnitGuy’s and St Thomas’ HospitalLondonUK
| | - Susanna Meade
- Inflammatory Bowel Disease UnitGuy’s and St Thomas’ HospitalLondonUK
| | | | - Polychronis Pavlidis
- Inflammatory Bowel Disease UnitGuy’s and St Thomas’ HospitalLondonUK
- School of Immunology and Microbial SciencesKing’s College LondonLondonUK
| | - Raphael Luber
- Inflammatory Bowel Disease UnitGuy’s and St Thomas’ HospitalLondonUK
| | - Sebastian Zeki
- Inflammatory Bowel Disease UnitGuy’s and St Thomas’ HospitalLondonUK
| | - Katie Hill
- Inflammatory Bowel Disease UnitGuy’s and St Thomas’ HospitalLondonUK
| | - Alexa Duff
- Inflammatory Bowel Disease UnitGuy’s and St Thomas’ HospitalLondonUK
| | | | - Sherill Tripoli
- Inflammatory Bowel Disease UnitGuy’s and St Thomas’ HospitalLondonUK
| | - Anna Stanton
- Inflammatory Bowel Disease UnitGuy’s and St Thomas’ HospitalLondonUK
| | - Andra Caracostea
- Inflammatory Bowel Disease UnitGuy’s and St Thomas’ HospitalLondonUK
| | - Sailish Honap
- Inflammatory Bowel Disease UnitGuy’s and St Thomas’ HospitalLondonUK
| | - Rebecca Reynolds
- Inflammatory Bowel Disease UnitGuy’s and St Thomas’ HospitalLondonUK
| | - Simon Anderson
- Inflammatory Bowel Disease UnitGuy’s and St Thomas’ HospitalLondonUK
| | - Shuvra Ray
- Inflammatory Bowel Disease UnitGuy’s and St Thomas’ HospitalLondonUK
| | - Joel Mawdsley
- Inflammatory Bowel Disease UnitGuy’s and St Thomas’ HospitalLondonUK
| | - Jeremy Sanderson
- Inflammatory Bowel Disease UnitGuy’s and St Thomas’ HospitalLondonUK
| | - Mark A. Samaan
- Inflammatory Bowel Disease UnitGuy’s and St Thomas’ HospitalLondonUK
| | - Peter M. Irving
- Inflammatory Bowel Disease UnitGuy’s and St Thomas’ HospitalLondonUK
- School of Immunology and Microbial SciencesKing’s College LondonLondonUK
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Fisher A, Hudson M, Platt RW, Dormuth CR. Tofacitinib Persistence in Patients with Rheumatoid Arthritis: A Retrospective Cohort Study. J Rheumatol 2020; 48:16-24. [PMID: 33004534 DOI: 10.3899/jrheum.191252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare medication persistence of tofacitinib with persistence of injectable biological disease-modifying antirheumatic drugs (bDMARD) in patients with rheumatoid arthritis (RA). METHODS We performed a retrospective new-user cohort study of patients with RA in the IBM MarketScan Research Databases. New users of tofacitinib or bDMARD were identified between November 2012 and December 2016. Persistence, in number of years, was the time between treatment initiation and the earliest occurrence of discontinuation or switching from the medication prescribed at cohort entry. Persistence of tofacitinib was compared with bDMARD persistence using Cox proportional hazards regression with adjustment for high-dimensional propensity scores. Similar methods were used for an analysis of post first-line therapy in patients who switched to tofacitinib from a bDMARD. RESULTS New tofacitinib users (n = 1031) were 56 years of age, on average, and 82% were women. New bDMARD users (n = 17,803) were 53 years of age, on average, and 78% were women. New tofacitinib users had shorter medication persistence (median 0.81 yrs) compared to bDMARD patients (1.02 yrs). After adjustment, the HR for discontinuation of tofacitinib compared with bDMARD was 1.14 (95% CI 1.05-1.25). Patients who switched to tofacitinib from a bDMARD had longer persistence than patients who switched to a bDMARD (adjusted HR for discontinuation 0.90, 95% CI 0.83-0.97). CONCLUSION Further research is warranted to understand the reasons for discontinuation of tofacitinib despite its ease of administration and to understand the observed differences between switchers and new users.
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Affiliation(s)
- Anat Fisher
- A. Fisher, Research Associate, MD, PhD, C.R. Dormuth, Associate Professor, ScD, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia;
| | - Marie Hudson
- M. Hudson, Associate Professor, MD, Division of Rheumatology, Jewish General Hospital and Lady Davis Institute, Department of Medicine, McGill University, Montreal, Québec
| | - Robert W Platt
- R.W. Platt, Professor, PhD, Departments of Pediatrics and of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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George G, Shyni GL, Raghu KG. Current and novel therapeutic targets in the treatment of rheumatoid arthritis. Inflammopharmacology 2020; 28:1457-1476. [PMID: 32948901 DOI: 10.1007/s10787-020-00757-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/05/2020] [Indexed: 02/07/2023]
Abstract
Rheumatoid arthritis (RA), a multifactorial disease characterized by synovitis, cartilage destruction, bone erosion, and periarticular decalcification, finally results in impairment of joint function. Both genetic and environmental factors are risk factors in the development of RA. Unwanted side effects accompany most of the current treatment strategies, and around 20-40% of patients with RA do not clinically benefit from these treatments. The unmet need for new treatment options for RA has prompted research in the development of novel agents acting through physiologically and pharmacologically relevant targets. Here we discuss in detail three critical pathways, Janus kinase/signal transducer and activator of transcription (JAK/STAT), Th17, and hypoxia-inducible factor (HIF), and their roles as unique therapeutic targets in the field of RA. Some of the less developed but potential targets like nucleotide-binding and oligomerization domain-like receptor containing protein 3 (NLRP3) inflammasome and histone deacetylase 1 (HDAC1) are also discussed.
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Affiliation(s)
- Genu George
- Biochemistry and Molecular Mechanism Laboratory, Agro-Processing and Technology Division, CSIR-National Institute for Interdisciplinary Science and Technology, Thiruvananthapuram, 695019, Kerala, India
| | - G L Shyni
- Biochemistry and Molecular Mechanism Laboratory, Agro-Processing and Technology Division, CSIR-National Institute for Interdisciplinary Science and Technology, Thiruvananthapuram, 695019, Kerala, India
| | - K G Raghu
- Biochemistry and Molecular Mechanism Laboratory, Agro-Processing and Technology Division, CSIR-National Institute for Interdisciplinary Science and Technology, Thiruvananthapuram, 695019, Kerala, India.
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Lambin T, Faye AS, Colombel JF. Inflammatory Bowel Disease Therapy and Venous Thromboembolism. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2020; 18:462-475. [PMID: 37063454 PMCID: PMC10100457 DOI: 10.1007/s11938-020-00304-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose of review To explore the relationship between IBD (inflammatory bowel diseases) therapy and VTE (venous thromboembolism) risk, as well as the safety, barriers, and utility of VTE prophylaxis. Recent findings In 2019, the Food and Drug Administration (FDA) issued a black box warning concerning the use of tofacitinib among ulcerative colitis (UC) patients with a post hoc analysis revealing that all patients had additional risk factors for VTE. Additionally, although IBD patients experiencing a disease flare often present with hematochezia, these patients are less likely to receive VTE prophylaxis, despite data showing that pharmacologic prophylaxis has not been associated with clinically significant signs of bleeding. Summary Among IBD patients, corticosteroid use has been associated with an increased risk of VTE, whereas anti-TNF therapy does not appear to increase this risk. High-dose tofacitinib has also been shown to increase the likelihood of VTE in patients with additional risk factors. In order to prevent future VTE events, pharmacologic thromboprophylaxis should be emphasized, particularly in hospitalized IBD patients, with recent data suggesting that a select population at risk may benefit from continued prophylaxis.
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Affiliation(s)
- Thomas Lambin
- Gastroenterology Department, CHU de Lille – Hôpital Claude Huriez, Université de Lille, Rue Michel Polonovski, 59037, Lille, France
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adam S. Faye
- Department of Medicine, New York-Presbyterian Columbia University Medical Center, New York, NY, USA
| | - Jean-Frédéric Colombel
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Rheumatoid Arthritis from Pathogenesis to Therapeutic Strategies. J Clin Med 2020; 9:jcm9082562. [PMID: 32784627 PMCID: PMC7465529 DOI: 10.3390/jcm9082562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 12/03/2022] Open
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Cantini F, Blandizzi C, Niccoli L, Petrone L, Goletti D. Systematic review on tuberculosis risk in patients with rheumatoid arthritis receiving inhibitors of Janus Kinases. Expert Opin Drug Saf 2020; 19:861-872. [PMID: 32552289 DOI: 10.1080/14740338.2020.1774550] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Janus kinases inhibitors (anti-JAKs), including tofacitinib, baricitinib, upadacitinib, and filgotinib, represent a new class of synthetic targeted drugs for the treatment of rheumatoid arthritis (RA). In this review, the risk of active tuberculosis (TB) occurrence in patients receiving anti-JAKs was assessed. The literature on this topic, updated to 29 February 2020 was reviewed. Overall, 40 reports (22 tofacitinib, 10 baricitinib, 5 upadacitinib, 3 filgotinib) were examined. A low frequency, not exceeding 0.25%, of active TB cases in patients were exposed to anti-JAKs. Only 1 of 89 recorded cases in tofactinib and baricitinib exposure occurred in countries at intermediate or high TB risk, and most of the cases probably were due to first mycobacterium tuberculosis (Mtb) exposure. Although no cases were observed in patients receiving upadacitinib and filgotinib, long-term trials and data from real-life are required to more precisely address the TB risk associated with the two drugs. AREAS COVERED Discussion on the TB risk associated with anti-JAKs, and on the need for accurate evaluation of host-related risk factors in high risk countries. EXPERT OPINION Available data on anti-JAKs suggest a negligible risk of active TB occurrence in low endemic areas.
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Affiliation(s)
| | - Corrado Blandizzi
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa , Pisa, Italy
| | - Laura Niccoli
- Rheumatology Department, Hospital of Prato , Prato, Italy
| | - Linda Petrone
- Translational Research Unit, Department of Epidemiology and Preclinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS , Rome, Italy
| | - Delia Goletti
- Translational Research Unit, Department of Epidemiology and Preclinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS , Rome, Italy
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Nasonov EL, Avdeeva AS, Lila AM. Efficacy and safety of tofacitinib for immune-mediated inflammatory rheumatic diseases (Part I). RHEUMATOLOGY SCIENCE AND PRACTICE 2020. [DOI: 10.14412/1995-4484-2020-62-79] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- E. L. Nasonov
- V.A. Nasonova Research Institute of Rheumatology; I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
| | | | - A. M. Lila
- V.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
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Solimani F, Meier K, Ghoreschi K. Emerging Topical and Systemic JAK Inhibitors in Dermatology. Front Immunol 2019; 10:2847. [PMID: 31849996 PMCID: PMC6901833 DOI: 10.3389/fimmu.2019.02847] [Citation(s) in RCA: 167] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/19/2019] [Indexed: 12/12/2022] Open
Abstract
Accumulating data on cellular and molecular pathways help to develop novel therapeutic strategies in skin inflammation and autoimmunity. Examples are psoriasis and atopic dermatitis, two clinically and immunologically well-defined disorders. Here, the elucidation of key pathogenic factors such as IL-17A/IL-23 on the one hand and IL-4/IL-13 on the other hand profoundly changed our therapeutic practice. The knowledge on intracellular pathways and governing factors is shifting our attention to new druggable molecules. Multiple cytokine receptors signal through Janus kinases (JAKs) and associated signal transducer and activators of transcription (STATs). Inhibition of JAKs can simultaneously block the function of multiple cytokines. Therefore, JAK inhibitors (JAKi) are emerging as a new class of drugs, which in dermatology can either be used systemically as oral drugs or locally in topical formulations. Inhibition of JAKs has been shown to be effective in various skin disorders. The first oral JAKi have been recently approved for the treatment of rheumatoid arthritis and psoriatic arthritis. Currently, multiple inhibitors of the JAK/STAT pathway are being investigated for skin diseases like alopecia areata, atopic dermatitis, dermatomyositis, graft-versus-host-disease, hidradenitis suppurativa, lichen planus, lupus erythematosus, psoriasis, and vitiligo. Here, we aim to discuss the immunological basis and current stage of development of JAKi in dermatology.
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Affiliation(s)
- Farzan Solimani
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Meier
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Bechman K, Yates M, Galloway JB. The new entries in the therapeutic armamentarium: The small molecule JAK inhibitors. Pharmacol Res 2019; 147:104392. [PMID: 31401212 PMCID: PMC6876279 DOI: 10.1016/j.phrs.2019.104392] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 02/07/2023]
Abstract
The past decade has witnessed an explosion in trial data on JAK inhibitors (JAKi). These small molecules target the Janus kinase - signal transducer and activator of transcription (JAK-STAT) pathway, blocking crucial cytokines across a septum of rheumatic diseases. As a class, JAKi are beginning to demonstrate efficacy on par, if not superior to biologics. Two first generation JAKi are licensed for use in inflammatory arthritis; tofacitinib and baricitinib. Next-generation JAKi have been designed with selective affinity for one JAK enzymes, the aim to reduce unwanted adverse effects without declining clinical efficacy. Emerging data with selective JAK1 inhibitors upadacitinib and filgotinib looks very promising. Despite differences in selectivity between JAKi, an overlap exists in their safety profiles. Across the class, a characteristic safety signal is emerging with viral opportunistic infections, particularly herpes zoster. Post marketing drug surveillance will be essential in evaluating the long-term risk with these agents.
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Affiliation(s)
- Katie Bechman
- Centre for Rheumatic Diseases, Kings College London, United Kingdom.
| | - Mark Yates
- Centre for Rheumatic Diseases, Kings College London, United Kingdom
| | - James B Galloway
- Centre for Rheumatic Diseases, Kings College London, United Kingdom
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